Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer

Objective： The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk （OAR） between five-field intensity-modulated radiotherapy （IMRT） and conventional three-dimensional conformal radiotherapy （3DCRT） in the radiotherapy of rectal cancer. Methods： Fifteen patients with rectal cancer treated with radio- therapy （RT） were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume （PTV）. The conformity index （CI） and homogeneity index （HI） were used for evaluation of the dose distribution in the target volume, and the Dx% （the lowest dose to the x% volume of the OARs that received the highest dose of irradiation） and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results： In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 （P = 0.000） and the HI were 1.13 and 1.17, respectively （P = 0.001）. For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively （P = 0.936）, and the mean dose were 30.14 Gy and 25.57 Gy, respectively （P = 0.001）. Conclusion： Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within ta     

Comparative proteomic study of cervical cancer with different radiotherapy sensitivity

Objective： To investigate the proteornic differences between the high-sensitivity （HS） group and low-sensitivity （LS） group of cervical cancer treated by radiotherapy and confirm the radiotherapy sensitivity associated proteins in early cervical cancer. Methods： The fresh carcinoma tissues were collected from 10 untreated cervical cancer patients and preserved in the -80 ℃ refrigeratory. The tissues were classified into two groups： high sensitivity group （HS） and low sensitivity group （LS）, according to their response to radiotherapy. In the first part of our experiment, protein separating was performed by using two-dimensional gel electrophoresis （2-DE） with Amersham 18 cm linear pH 3-10 immobilized pH gradient （IPG） strips. The images of the gels were acquired by the scanner and then analyzed by using PD-quest7.3 software to find the differentially expression protein-spots in each group. Then the differentially expressed protein-spots was incised from the gels and digested by trypsin. The peptide mass fingerprintings （PMF） was acquired by matrix assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS） and the proteins were identified by data searching in the Mascot-database. Part of differentially expression proteins were assayed by Western Blot. Results： Most of the gels were clear and successfully analyzed by PD-quest7.3 software. Most of the protein-spots concentrated on the area of 20-100Kda （Mw） and pH4-8. The average number of the protein-spots was 754 ± 64 in HS group and 777 ±48个 in LS group. The match rate was 87.6% between two groups. Five high expression proteins were found in HS group which were low expression in LS group, 3 high expression protein were found in LS group which were low expression in HS group. Reselts of Western Blot were in coincidence to proteomic result. Conclusion： The 2-DE gels image of HS group and LS group with early cervical cancer tissues treated by radiotherapy are successfully acquired. Some di     

Experience of endometrial stromal sarcoma with fertility conservation treatment

The paper introduced the experience of a case of recurrence of endometrial stromal sarcoma with fertility conservation treatment after full-term delivery. A 24-year-old unmarried patient who, with her increasing amount of menstruation in the late six months, had a mass in her lower-abdominal which was confirmed by B-ultrasonic diagnosis as myometrium mixed mass, was given an enucleation of uterus tumor. The pathological examination of tumor sample revealed it as lowgrade endometrial stromal sarcoma （LESS）. And the patient underwent 6 cycles of chemotherapy over 8 months before she got pregnant and had a full-term delivery. But in 34 months after delivery, the disease recurred with metastatic of pelvic and peritoneal cavity and the patient had to receive comprehensive therapy. Conclusion： The unmarried young patient with stage I low-grade endometrial stromal sarcoma has the chance to preserve uterus for her pregnancy and delivery. But the using of cesarean needs do staging operation and prognosis evaluation.     

Clinical study of docetaxel combined with concurrent radiotherapy in patients with advanced nasopharyngeal carcinoma

Objective： The aim of this study was to study the short-term curative effects and adverse reactions of docetaxel （DOC） in concurrent chemoradiotherapy compared to DDP plus 5-Fu （DF） combined with concurrent radiotherapy in patients with advanced nasopharyngeal carcinoma. Methods： Thirty-three patients in the experimental group （DOC group） were given DOC 25 mg/m2 ivgtt, dl, 7 times, concurrent radiotherapy was performed from dl. Thirty-three patients in the control group （DF group） were given cisplatin 25 mg/@ivgtt dl-3 and 5-Fu 550 mg/m2iv, dl-5, 3 weeks a cycle, 2 cycles, and concurrent radiotherapy was performed from dl. Six MV X-ray and 9 MeV electronic line for external irradiation were adopted in concur- rent radiotherapy. Results： The response rates of DOC group and DF group were 90.9% and 93.9%, the rates of neutropenia were 45.45% and 67.74%, and the rates of oral mucositis were 60.61% and 90.32%. Conclusion： The difference of short- term curative effects between DOC group and DF group was not statistically significant in patients with advanced nasopha- ryngeal carcinoma. The rates of adverse reactions were lower in DOC group. DOC combined with concurrent radiotherapy could be a new choice for patients with advanced nasopharyngeal carcinoma.     

Experience with the surgical treatment of patients with both esophageal carcinoma and bullous emphysema

Objective： We aimed to investigate the security and feasibility of the simultaneous surgery for patients with both esophageal carcinoma and bullous emphysema. Methods： We described simultaneous surgery performed on 49 cases with both esophaoeal carcinoma and buUous emphysema, accounting for 2.5% of all esophagectomy patients from January 2000 to January 2003. Radical resection of upper and mid-thoracic esophageal cancer was performed in 31 cases, including three approaches from the right chest, left neck and midsection. Thirty-six patients were underwent cervical anastomosis and 13 cases were operated by intrathoracic anastomosis. Results： No perioperative period death occurred. And postoperative com- plications were as follows： cervical anastomotic leakage in 9 cases, lung infection in 11 cases, pulmonary air leak in 13 cases （2 cases lasted for 4 weeks）, recurrent laryngeal nerve damage in 4 cases, supraventricular tachycardia in 4 cases. Patients all recovered and left the hospital with average hospitalization time of 17.5 days. Conclusion： Patients with both esophageal carcinoma and bullous can perform the esophageal carcinoma resection and lung volume reduction surgery （LVRS） simulta- neously. It will not increase the mortality rate and show the feasibility and safety in patients.     

The effects of three-dimensional conformal radiotherapy combined with whole brain irradiation on brain metastases

Objective： To observe the recently therapeutic effects and toxicity of three-dimensional conformal radiotherapy combined with whole brain irradiation for patients with brain metastasis. Methods： 33 cases were treated by whole brain irradiation at first, the dose of which was 36-40 Gy （18-20 f）. Then three-dimensional conformal radiotherapy was added to the focus with a total dose of 20-25 Gy, whose fractionated dose was 2-5 Gy/time, 5 times/week or 3 times/week. Results： Within 1 month after radiotherapy, according to imaging of the brain, the CR of all patients was 45.5%, PR 36.4%, NC 15.1%, and PD 3%. For the 32 cases with neural symptoms before radiation, the CR of the symptoms was 40.6% and PR 59.4%. All patients gained different increases in KPS grade. By the end of the follow-up period, there were 22 deaths with the mean survival time up to 9.3 months. Conclusion： Three-dimensional conformal radiotherapy combined with whole brain irradiation can not only effectively control brain metastases and improve life quality, but also tends to prolong survival time.